{"entity":{"id":"idea-fund-older-patients-trial-fund","kind":"idea","name":"A trials fund reserved for older and multimorbid patients","aka":[],"tldr":"Most people with cancer are over 65, but most trial patients are younger and fitter. A dedicated fund would pay for trials designed for the patients we actually treat.","summary":"Public and charitable funders create a standing fund for trials with inclusive eligibility (age, kidney function, performance status, comorbidity), geriatric assessment-guided dosing, and endpoints that matter to older adults (function, independence, time at home). Trials would test dose reductions, shorter courses and de-escalation of standard regimens in patients over 70, where retrospective data suggest toxicity and discontinuation are far higher than in trials. Industry has little incentive to run these because they mostly test less drug.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Funding follows fashion, not burden): Carter & Nguyen, A comparison of cancer burden and research spending (BMC Cancer 2012)","url":"https://doi.org/10.1186/1471-2407-12-526"}],"tags":[],"related":["idea-fund-payer-funded-pragmatic-trials","idea-fund-implementation-quota"],"cancers":[],"sections":[],"technologies":["geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-funding-allocation","b-aging-comorbidity","b-trial-diversity"],"keyPapers":["paper-sun-bmc-cancer"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A dedicated fund produces at least five phase 3 results in older adults within eight years that change guideline dosing or regimen choice, and increases the median trial age in the funder's portfolio by at least five years.","rationale":"The GAP70+ and GAIN trials showed geriatric assessment reduces toxicity; French GERICO and UK trials demonstrated feasibility of elderly-specific phase 3s. The gap is sustained funding, not method.","test":"Launch the fund for one cycle and compare median participant age, toxicity-driven discontinuation and guideline impact with the funder's general trials portfolio.","maturity":"speculative","actor":"policy","cost":"medium","horizonYears":4},"route":"/ideas/idea-fund-older-patients-trial-fund/","neighbours":{"idea":[{"id":"idea-fund-implementation-quota","kind":"idea","name":"A fixed share of trial-group funding for getting proven care to patients","route":"/ideas/idea-fund-implementation-quota/"},{"id":"idea-fund-payer-funded-pragmatic-trials","kind":"idea","name":"Payers fund trials of cheaper, shorter or lower-dose versions of expensive treatments","route":"/ideas/idea-fund-payer-funded-pragmatic-trials/"}],"technology":[{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/"}],"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"}],"paper":[{"id":"paper-sun-bmc-cancer","kind":"paper","name":"Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a meta-analysis of the randomized controlled trials","route":"/key-papers/paper-sun-bmc-cancer/"}]}}